“When you think about chronic kidney disease, it affects so many people,” explains Dr. Kathleen Robischon, VP of Medical Affairs and Clinical Services at Excellus BlueCross BlueShield.  “Any interventions we can take to slow the progression of the disease are a plus.”

People are diagnosed with chronic kidney disease (CKD) when their kidneys are damaged and unable to perform their normal function of filtering blood. The National Institutes of Health estimates that 1 in 7 adults has a form of CKD. As the disease progresses, kidney function continues to decline.

“When managing chronic kidney disease, we want to reduce risk factors, limit damage to the kidneys and slow progression of the disease,” adds Dr. Robischon. “We provide care management for members with chronic kidney diseases stages 1 through 3. When a member moves into stage 4, we offer the support of REACH Kidney Care.”

How REACH Kidney Care helps

REACH Kidney Care* is a kidney health management program designed to help members with stage 4-5 chronic kidney disease navigate services and follow their physician’s treatment plan. Members work one-on-one with a multi-disciplinary care team that provides personalized support to help members make the most of their care and manage their CKD. The REACH program is offered virtually, over the phone and in-person at no cost to members that have this benefit included in their plan. The goal of the program is to improve care while delaying the need for more costly interventions such as dialysis.

“We are pleased that our eligible patients have the opportunity for additional support and resources,” explains Dr. Philip T. Ondocin of Nephrology Associates of Syracuse, PC. “We encourage all patients to maximize their insurance benefits to support their kidney function and slow down the progression of their disease.”

Caring for a loved one with kidney disease

ElenaMarie Burns, Excellus BCBS Provider Programs Project Coordinator, faced the challenges of navigating CKD when her father suffered a stroke in his 50s that led to the discovery that his kidneys were not functioning properly.

As his primary caregiver, her father’s CKD diagnosis marked a significant change in ElenaMarie’s life. “We had to uproot everything because he could not take care of himself,” she explains. This meant giving up her full-time job and moving with her young son to her father’s house to provide the care he needed.

She remembers times when her father would stop taking his medication or resist following the doctor’s dietary instructions. “We didn’t have someone to sit and talk to him, like a care management team, that would say ‘hey let’s take a look at all the medications you are taking, hey let’s find out what is going on here’… to have that collaboration of care. I think he could have benefited from that,” says ElenaMarie.

Within a couple of years of diagnosis, her father began dialysis, which eventually meant waking up early and traveling in a medical van to the hospital multiple times each week. “The dialysis really did a number on him,” explains ElenaMarie. “This was a very robust individual and seeing him go down to 140 pounds in the end, he did not look like my dad anymore.”

Support for managing CKD

Dr. Robischon notes that ElenaMarie’s experience is not uncommon as patients and caregivers often face challenges managing multiple medications and doctor’s visits. “There is a lot of information and responsibility that falls on the patient to try to keep track of all of this,” says Dr. Robischon. “REACH works to help support our members and make sure they are getting their labs done and following up with medications and more.”

These care management services were not available when ElenaMarie was caring for her father. Knowing what is available to patients and caregivers now, she says, “I think that education [provided by the care management team and REACH Kidney Care] would have given my father a better quality of life.” And she sees the benefit it would have brought to her as a caregiver. “Having the support and a cheerleading squad pointing me in the right direction would have been so important.”

*REACH Kidney Care is an independent not-for-profit that offers kidney disease management support to Excellus BlueCross BlueShield members.

Did you know that Excellus BlueCross BlueShield is supported by a team of local Medical Directors?  That’s right, a team of 27 doctors who live and work right here in our communities serve as Medical Directors for the health plan. This diverse group includes medical, dental and behavioral health specialists. Their work ensures that every one of our members is receiving equitable, high-quality care that’s as affordable as possible. It’s not only a love of science and medicine that drew them into the profession, but an innate need to help, heal, and serve others.

Working with community doctors

A strong relationship with community providers is essential to providing quality care to our members. As board certified physicians with years of experience caring for patients in hospitals and outpatient settings, our Medical Directors work together with our local providers to improve quality and control costs by identifying opportunities to close gaps in care, and better controlling chronic health conditions.  An example of this is our value-based payment arrangements where we reimburse doctors based on the quality of care they deliver and not just the number of services they perform. Providers can receive higher reimbursement when they meet goals around quality, experience and affordability. This is one of the ways we work with doctors to improve care while controlling costs.

This team actively collaborates with our provider partners, seeking their input and feedback in areas such as medical policy, quality improvement and medical management. This collaboration leads to improved member care and healthier communities.

Improving member wellbeing

Our Medical Directors seek out innovative opportunities to engage our members in enhancing their health and wellbeing. This dedicated group of physicians serves as advisors and leaders for dozens of initiatives. For example, in 2024 we introduced a new virtual physical therapy option to help our members manage musculoskeletal disorders from the comfort and convenience of a virtual environment. And we have partnered with a kidney care management program to help members with stage 4-5 chronic kidney disease navigate medical care services and follow their physician’s treatment plan.

Our code of ethics

They tackle big issues such as health care disparities, rising costs, and a changing health care landscape while following a code of ethics rooted in trust.  This code embraces quality and patient safety in clinical decision-making.  Our Medical Directors define quality care as safe, effective, patient-centered, timely, efficient, and equitable. Their decisions are guided by evidence-based standards of care and the expertise of community providers.

Proud to live in the local area

Our Medical Director team is proud to call the upstate New York area home.  You might see them out in your neighborhood enjoying time with their family, running errands, or participating in community events. Get to know our Medical Directors by visiting our website to learn more. 

The Monroe County Family Coalition is one of Excellus BlueCross BlueShield’s 2023 Health Equity Innovation Award recipients. Funds will be used to provide more mental health wellness, support and education to youth and families, develop a peace garden to address food deserts and nutrition shortages in underserved communities, and enhance financial literacy and crisis support resources.

“We want to meet people where they are and make sure that no one is left behind,” says Dina Johnson, president and CEO of Monroe County Family Coalition. “Addressing inequities and health disparities in our community is vital to the success of our youth and families and we couldn’t do it without partnerships like the one we have with Excellus BlueCross BlueShield.”  

Hear from two women who share very different experiences of how The Monroe County Family Coalition has impacted their lives.  

As an active community member and local senior center volunteer, Richard doesn’t like to sit still. However, sciatic nerve pain can slow him down.    

“I wish I had changed health plans earlier. I am saving money on doctor visit copays and two prescriptions that I take,” says Richard. “I have much better coverage, the service I receive is awesome, and I have a friend in Helen.”  

Helen Pleszewicz, Medicare Consultant, met Richard for the first time in their apartment complex parking lot.

“I would be out walking my dog and see Richard outside and we would just start talking. We were neighbors and we got to know each other,” says Helen. “We talked about health insurance coverage, what he liked, what he didn’t like, and I mentioned when it comes time, let’s see what the plans are, and we can sit down and compare.”

So that’s what they did. Richard was particularly interested in his dental coverage, having paid extra for it on his previous plan. He quickly learned it was part of our Medicare benefits.

“There was no pressure. I felt so relaxed and informed. Medicare can be complicated, but Helen took the time and explained everything to me, so I was aware of my coverage, and I decided to make the change. I’m so glad I did,” says Richard.

“It’s personal to me. I’m working with people who are part of my community, they are like family and it’s important to show people we are local. You never know the impact you could have on someone just by having a conversation,” says Helen.

There’s no slowing Richard down. He’s joined a senior exercise class and says eating right, and being around family and friends, is what keeps him motivated, happy, and as healthy as he can be.

Hear more from Helen and Richard in this video.
https://youtu.be/sgducYfAiNo